MEDICARE: LOUISIANA CNI, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	888	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144325895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISIANA CNI, LLC

Provider Business Mailing Address
First Line	:	12009 FLORIDA BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-2702
Country	:	US
Telephone Number	:	225-272-2090
Fax Number	:	225-273-4305

Provider Business Practice Location Address
First Line	:	624 PONDEROSA DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70819-4027
Country	:	US
Telephone Number	:	225-275-3932
Fax Number	:	225-273-4305

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	TONI RIZZO
Credential	:
Telephone Number	:	225-272-2090

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/22/2020

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